Healthcare Provider Details

I. General information

NPI: 1053006643
Provider Name (Legal Business Name): BRANDON CRATTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N FORGE ST
AKRON OH
44304-1407
US

IV. Provider business mailing address

141 N FORGE ST
AKRON OH
44304-1407
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3361
  • Fax:
Mailing address:
  • Phone: 330-375-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.018480
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: